- Etiology: congenital, is high if rectal pouch is above levator sling, is low if rectal pouch is below levator sling
- Imaging: high atresia – rectourethral fistula demonstrated by colostomy injection, enterolith – intraluminal meconium may calcify when mixed with urine from rectourethral fistula
- Complications: rectoperinal fistula – 95% of anorectal malformation have recto-perineal fistula, in male 50% goes to urethra + 30% goes to seminal vesicle, in female 40% goes to urethra + 30% goes to vestibule + 25% goes to vagina, often have continence issues post op
- Clinical: have VACTERL syndrome which consists of Vertebral body segmentation anomalies, Anal atresia, Cardiac anomalies, TracheoEsophageal fistula, Renal anomalies, and Limb anomalies (radial ray hypoplasia)
- Radiology management to assess for associated VACTERL defects:
— Spine and sacrum – AP+lateral spine radiography including AP + lateral sacrum, spinal US for tethered cord, pelvic MR if sacral mass detected (sacral teratoma or anterior meningocele)
— Congenital heart disease – echocardiogram
— Esophageal atresia – nasogastric tube placement then CXR + AXR
— Genitourinary – renal and bladder US
— Limb radiographs as clinically indicated
— In female with cloaca, get renal + pelvis US to look for hydrocolpos
— Assess for recto-urethral fistula in male prior to repair with distal colostogram
— Assess cloaca prior to repair with 3D cloacagram
Radiology Cases of Anorectal Malformation




Clinical Cases of Anorectal Malformation


